PNHP

Some big insurers leery of exchanges

Some big insurers leery of exchanges

Big US health insurers wary of ‘Obamacare’ exchanges

By Stephanie Kirchgaessner
Financial Times, September 3, 2013

Some big US health insurers, including Cigna, Aetna and UnitedHealthcare, are steering clear of most of the new state healthcare exchanges amid uncertainty about the kinds of customers they might attract: namely sick ones.

The three companies have said they are taking a cautious approach because they need to evaluate how the markets – set up under the “Obamacare” reforms – will work. They add that they are specialised in providing insurance to big employers, not the individuals and small businesses that will be served by the exchanges.

An Obama administration official said risk adjustment and reinsurance programmes under the law were designed to offer incentives to health insurers to make sure they do not avoid enrolling customers with the greatest needs.

A spokesman for Cigna, which is participating in five of 50 new exchanges, agreed that the provisions would help the company manage risk.

UnitedHealthcare said it would participate in about 12 exchanges initially, but said the exchanges had the “potential to be a growth market” over time.

A spokesman for Aetna said it would participate in up to 14 exchanges. It emphasised that it planned to position itself “for the future”.

http://www.ft.com/cms/s/0/f17b5ea4-10a4-11e3-b291-00144feabdc0.html#ixzz2dwahA63N

Comment:

By Don McCanne, M.D.

UnitedHealthcare, Aetna, and Cigna – three of the largest private insurers in the nation – have decided to not participate in most of the state exchanges being established under Obamacare. Obama and his health care architects had told us that it was better to build on the system we had, expanding the prevalence of private insurance. With this gift of a ready-made market for the private insurers, why are they sneaking away?

America’s private insurers have always welcomed the healthy and shunned the sick. The greatest example is the largest insurance market of all – America’s workers and their families – not only the largest market in the nation but also the healthiest.

In contrast, the individual and small group markets exposed insurers to greater risks, so they countered by using underwriting to select only the healthy while rejecting those who needed health care. In turn, Obamacare now prohibits selective enrollment – cherry picking and lemon dropping. Insurers rightfully fear that those with greater health care needs will rush into the exchanges, creating high cost risk pools that would price premiums out of the market.

About 31 million people will remain uninsured. They are healthier than average since they will include young invincibles who would rather take a chance, hard working immigrants and their families, many of whom are prohibited from participating, lower-income workers who are exempt because of lack of affordable plans for them, and families with incomes high enough to disqualify them from subsidies yet low enough that they will find the premiums to be unaffordable, especially for plans that still leave them exposed to the out-of-pocket expenses of high deductibles and other cost sharing.

These big insurers aren’t dumb. If they are going to sell plans in the exchanges, they want most of these low-cost individuals included in order to dilute the high costs of the sick who will enroll, thereby allowing the insurers to offer competitive premiums. Quite clearly, they are not convinced that will happen.

Will delaying a year result in an influx of some of these healthy individuals into the plans? Look at the list again. Likely some of the previously healthy who develop medical problems will want in. But that will increase the costs of the pools even more, causing the healthier to disenroll because the premiums are driven up further – the classic problem of the death spiral of skyrocketing health insurance premiums.

We should listen to UnitedHealthcare, Aetna, and Cigna. This is a highly flawed method of financing health care. It just doesn’t make sense from a business perspective. But also we should give some thought to this ourselves. Does it really make sense to to insert an administratively wasteful insurance intermediary that has found great success in manipulating the markets so that they can welcome the healthy and shun the sick? Medicare Advantage has already proven to us that private insurers will always find a way around risk adjustment and other regulations in order to shift costs away from them and onto taxpayers.

Obama and friends crafted this program to take good care of the insurers while depriving us of a less costly, more efficient and more effective social insurance program – an improved Medicare for all – and yet the insurers are still not satisfied. It’s too bad that we are going to have to wait until 2015 and 2016 to see premiums skyrocket and insurers bail out.

What will be our response then? Will we let the insurers continue to cover the healthy while accepting for the rest of us the fact that financial hardship is simply an inevitable consequence of facing serious illness? Based on the lack of public engagement to this date, it seems like that is where we are headed.

How Obamacare compounds inadequacies

By Marc Landry
News and Observer (Raleigh, N.C.), Sept. 3, 2013

With the imminent rollout of open enrollment under Obamacare, we are all going to read and hear a great deal about health care and health insurance in the weeks and months to come.

To gain some international perspective on these issues, I highly recommend reading “The Healing of America” by T.R. Reid.

Reid, a correspondent for The Washington Post, writes of his journey around the world to experience the health care and insurance regimens of other countries. Citing a study from the National Academy of Sciences that claims 22,000 Americans die prematurely each year from treatable medical problems because they cannot afford to see a doctor, he asks the essential question:

“Should our country provide health care to all of its citizens who need it?”

To date, the United States is alone in the developed world to have answered with an emphatic “no.”

It is disgraceful that we allow tens of thousands of our fellow citizens to die prematurely because our decision-makers will not say “yes” to what is essentially a moral question.

Will Obamacare provide all Americans with the access to health care they need? Again, emphatically no. It will extend coverage to many who are now uninsured, but millions will continue to do without.

Obamacare extends coverage in the most inefficient way possible, building on the hodgepodge of health insurance regimes that already exist. And because Obamacare subsidizes the purchase of insurance coverage, it is essentially nothing more than a pipeline from taxpayer pockets to the coffers of the health insurance industry.

There are four health care delivery models, and the United States is the only country where all co-exist.

Americans are well-acquainted with the Bismarck model, which uses private health insurance plans and providers and is paid for by employers and employees through the payroll system. There are variations of the Bismarck model in Germany, France, Japan, Belgium, Switzerland and many parts of Latin America. Most working Americans under 65 get their health coverage this way.

In the Beveridge model – the inspiration for the National Health Service introduced in the United Kingdom in 1946 – the government pays for health care from general tax revenue. Medical treatment is a public service, and the government owns and operates the hospitals and clinics. The Beveridge model is what most Americans have in mind when they think of “socialized medicine.” Variations are found in Italy, Spain, Scandinavia and Hong Kong. Americans who get their health care this way are members of the military, veterans and American Indians.

The third model is national health insurance, which incorporates elements of both Bismarck and Beveridge. In countries using this model, every citizen pays premiums to the government, which in turn pays all medical bills. The medical providers are private, but the single-payer system gives the government considerable power to negotiate on price. Canada adopted its “Medicare” system in the 1960s, and newly industrialized countries such as Taiwan and South Korea have adopted variations. Americans over 65 should be familiar with this model as our own Medicare is an example.

Lastly, you have the out-of-pocket model found in most of the poorer countries where the rule is you get the health care you can afford. Think Burma and Rwanda – and the United States, where 45 million Americans are well-acquainted with this model.

Reid’s book concludes with a chapter that tries to answer the question: “Which are the best health care systems in the world?”

The United States ranks No. 1 in terms of absolute spending, per capita spending and spending as a percentage of GDP. The World Health Organization gathered all of the factors on which health care systems can be rated, synthesized the data and ranked the health care systems of 191 countries. We came in 38, just behind Costa Rica.

When you go to a Target store, banners proclaim, “Expect more. Pay less.” When it comes to health care, we in the United States have turned that around: “Pay more. Expect less.”

Marc Landry is a contributing columnist. He can be reached at marclandry49@gmail.com.

Read more here: http://www.newsobserver.com/2013/09/03/3161455/how-obamacare-compounds-inefficiencies.html#storylink=cpy

National group launches universal health care drive in Augusta

By Paul Koenig
Kennebec (Maine) Journal, Sept. 4, 2013

AUGUSTA, Maine — Supporters of a government-funded universal health care system rallied on Tuesday outside the State House for the launch of a 10-day tour of eight cities considering legislation for their cause.

About 10 people gathered along Capitol Street held signs bearing messages such as “People Over Profits,” encouraging passing drivers to honk if they supported universal health care.

Representatives from Maine AllCare, the Maine chapter of Physicians for a National Health Program — a national organization advocating for single-payer health care — joined the Chicago-based Drive for Universal Healthcare at its stop at the State House.

Rep. Charlie Priest, D-Brunswick, who is co-sponsoring a bill to establish a single-payer health care system in Maine by 2017, spoke at a news conference about the proposed legislation before the demonstration outside.

The bill, L.D. 1345, eventually would transition a state exchange under the federal Affordable Care Act into a state-funded health care system, Priest said. He expects the Health and Human Services Committee to take up the bill in February or March.

The legislation’s goal is to provide affordable, quality health care to all Maine people and try to take the burden of employees’ health insurance away from employers, Priest said.

He thinks it’s possible the bill will pass in the Legislature, but it could face a veto from Gov. Paul LePage, who vetoed a bill to expand Medicaid under the Affordable Care Act last session and opted to not take part in the state health insurance exchanges that are part of the federal law.

LePage described the Affordable Care Act as a stepping stone to a single-payer system in a November letter to the Obama administration.

However, some supporters of a single-payer system say the federal law shows why the country needs a different approach to health care because not everyone will be guaranteed insurance under it.

Priest said he thinks the Affordable Care Act will be expensive, and people in the middle class who don’t qualify for the subsidies to buy insurance on the exchanges will find costs increasing.

He also said congressional Republicans’ repeated attempts to repeal the law increase its uncertainty.

The hope with starting a universal health care system in the state is that federal government eventually will adopt a national system if enough states show their support for it, Priest said, calling such a development similar to what happened in Canada.

Fred Horch, a member of Maine AllCare, said it’s not an ideal course, but it may be the only realistic way to make universal health care a reality in the United States.

Horch, the former owner of a sustainable supply store in Brunswick, said he doesn’t think health insurance should be tied to employment status. If people with health insurance through their employers lose their jobs, they may end up uninsured when they’re most vulnerable, Horch said.

Health insurance also adds a burden on small-business owners, he said.

Horch, who didn’t pay for health insurance for his employees at F.W. Horch Sustainable Goods & Supplies, said he sometimes struggled to hire people because some were looking for a job that provided it. By not offering insurance, his store was at a disadvantage compared to large retail chains that could afford it, Horch said.

“It’s making it so hard for our small businesses to stay in business,” he said.

Rep. Richard Malaby, R-Hancock, a small-business owner himself, said he agrees that health insurance shouldn’t be tied to employment and thinks it’s one reason for rising health care costs.

Even so, he said he doesn’t think a single-payer system is the answer. Instead, Malaby, a member of the Health and Human Services Committee, said he wants to see greater competition among insurance companies and more openness about pricing in the medical industry to allow people to shop around for medical care.

Another reason Malaby said he’s against single-payer health care is that people wouldn’t have “skin in the game” if the government was footing the bill.

“Then they don’t shop for a good value for prices, and they don’t always make decisions based on it,” Malaby said.

He also said he sees health care as a personal responsibility, not a human right. He said people can help ensure they stay healthy through a healthy diet, exercise and good lifestyle choices.

“I’m not of the mind that the government should be paying,” Malaby said. “When other people pay, you don’t care as much about how much you spend.”

http://www.kjonline.com/news/National-group-launches-universal-health-care-drive-in-Augusta.html

Single-payer health care supporters kick-off nationwide drive

By A.J. Higgins
Maine Public Broadcasting Network, Sept. 3, 2013

AUGUSTA, Maine — Supporters of a single payer national health care system kicked off an eight-city tour in Augusta today. Members of the Drive for Universal Healthcare organization also expressed support for a bill that will be taken up next year at the State House that would establish a single payer system in Maine modeled after a similar program in Vermont. Both plans face opposition from critics who say Maine can’t afford universal health care.

Even Sue Saltmarsh, the founder of the Drive for Universal Healthcare organization, admits that promoting a group with the acronym of D-U-H ‘spell out the letters’ may not evoke admiration and respect ‘does raise some eyebrows and cause a few snickers?’. But then again, the Chicago resident also sees its value.

“It’s sort of a universal word that people understand for universal healthcare,” Saltmarsh said. Does America need a new healthcare system? Duuh-uhh.”

During a State House press conference, Saltmarsh recounted her own personal healthcare crisis that left her $30,000 dollars in debt. Realizing that a national health care plan similar to the government sponsored program in Canada is a difficult sell in Washington, Saltmarsh says she now wants to build new support at the local level.

“I can’t change the world, but I’m determined to change all the towns I’m going to and I’m hoping that along the way, people will get in their cars and drive for an hour or two, go home and talk about it to their neighbors and get encouraged and energized to be a part of the movement actively,” Saltmarsh said.

Saltmarsh is being supported in her universal health care effort by Maine AllCare spokesman, Fred Horch, of Brunswick. A former businessman, Horch says the essential problem with the American healthcare system is that it is TIED to individual employment — rather than perceived as a business expense that should be underwritten by the state or federal government.

“In our country — in contrast to other developed countries, we have tied health insurance to employment status,” Horch said. “This puts an enormous burden on our small business community and of course magnifies the impact of losing your job, putting enormous and unnecessary stress and strain on our peoples and family,” Horch said.

That’s why Horch and DUH support LD 1345, a bill to establish a single payer plan in Maine sponsored by state Rep. Charles Priest. a Brunswick Democrat. He says his bill — which was carried over last spring to next year’s legislative session — has been revamped to resemble a more measured approach currently being undertaken in Vermont.

“It builds off the Affordable Care Act which we think needs to be implemented statewide and not federally, but it also provides for a Maine health plan which is set up with the advice of an advisory com
mittee which helps to plan this health plan,” Priest said.

“Maine simply can’t afford it — it’s as simple as that,” said former state Rep. Jon McKane.

Former Republican state representative — and longtime universal health care foe — Jon McKane of Newcastle says the costs associated with a universal plan would be prohibitively expensive for Maine to go it alone. Dan Bernier, a lobbyist for the Maine Insurance Agents Association agrees. He says there are darker consequences for those in countries with national health care plans.

When you make health care free, people will consume more of it and when people consume more of it you then need to find a way to control consumption,” Bernier said. “So a government run system ultimately leads to government rationing.”

Members of the Drive for Universal Healthcare organization plan to visit with supporters tomorrow in Vermont.

http://www.mpbn.net/Home/tabid/36/ctl/ViewItem/mid/5347/ItemId/29768/Default.aspx

Uwe Reinhardt on household income and health care costs

The Central Challenge in U.S. Health Policy

By Uwe E. Reinhardt
The New York Times, Economix, August 30, 2013

“Health Care Costs Climb Moderately, Survey Says” read the headline in The New York Times last week. It appears that health insurance premiums for job-based family coverage rose “only” 4 percent between 2012 and 2013, although still twice as fast as did wages.

The survey in question is the Kaiser Family Foundation’s annual survey of employment-based health insurance, widely viewed as a gold mine for anyone seeking information on that part of the American health system.

For example, 21 percent of the companies in the Kaiser survey paid premiums in excess of $19,387 for families and in excess of $7,062 for singles in 2013 — a hefty amount. At the other end, about a fifth of the companies in the sample paid less than $13,225 for family coverage and less than $4,708 for single coverage.

The benefit consulting firm Milliman annually publishes its Milliman Medical Index on the average total cost of health care for a typical American family of four under age 65, covered by a preferred provider plan, or P.P.O. That index includes not only the employment-based health insurance premium paid by employer and employee but also an estimate of the family’s out-of-pocket spending. In other words, if estimates total annual health spending for the hypothetical family.

According to Milliman’s report, the total cost of $22,030 in 2013 is composed of a total premium for insurance coverage of $18,430, of which the employer is estimated to contribute $12,886 and the employee $5,544. The rest represents out-of-pocket spending of $3,600.

Although not directly comparable, taken together these two data series raise the question of how many American families could afford this kind of health spending strictly with their own financial resources, if one took the extreme position that health care is a private consumption good for which American households themselves should be financially responsible. I hasten to add that I do not know anyone who actually holds that extreme position; the argument is and always has been only over how extensive such support should be.

But the numbers are daunting just the same, if one contrasts them with data on the distribution of household money income (after taxes and transfers) by income group.

It is seen that in 2011, 20 percent of American households had incomes below $20,262. Although the figure includes households of various sizes, including singles, it is nevertheless a small sum to absorb even Kaiser’s premium numbers for single coverage. Median household income in 2011 was $50,054, meaning that close to 50 percent of households had an income below that number.

While the nominal median household income (in current dollars, not adjusted for inflation) in the United States has increased substantially since 1975, in constant-dollar terms of 2011 it has been remarkably and disappointingly flat.

Most of the growth in real gross domestic product in the last several decades has actually accrued to households in the top quintile of the income distribution and, within that quintile, to the top 1 percent.

The gist of the preceding array of data is that even under what we now call “moderate” growth in health care costs, stagnating incomes for millions of American households will put American health care as we have come to know it out of their financial reach, unless they receive substantial help from households in the upper third or so of the household income distribution.

This central political dilemma in American health policy — leave health care to those who can afford it or increase tax revenues to broaden coverage — will continue as far as the eye can see. A good part of the current shouting match over the Affordable Care Act expresses anger over this dilemma, and it will not subside even after the act has been fully put in place.

NYT Reader Comments:

Don McCanne, San Juan Capistrano, CA

With typical family health costs at $22,000 and median household income at $50,000, clearly there must be a transfer from wealthier, higher-income individuals if everyone is to have the health care that they should have.

Although the Affordable Care Act moves in that direction by providing income based subsidies for exchange plans and expands Medicaid for low-income individuals, most people still obtain their health coverage through their employment. Since employer-sponsored insurance is paid for through forgone wage increases, health care costs contribute to the failure of most of us to share in the gains that the very wealthy have made.

The easiest solution is to end individual plans with their premiums based on average pooled costs and set up a single pool for our entire health care system that is funded based on ability to pay – automatically resulting in that transfer that we need.

That’s easiest except for one thing. Those who have fared so well in our economy must decide that a transfer that improves the health of the nation is worth pursuing. So far, we haven’t heard much from them.

Virginia, Boston

The ‘Medicare for all’ proposed by Physicians for National Health Program at pnhp.org has been in place for twenty years. The program is reflected in a current bill in the House, HR 676, brought by D-MI Rep. John Conyers. How likely is it that our corrupt and paid-for-by-lobbyist congress will honor that attempt to right the wrong of for-profit health “care”, and pass such a bill. Please take a look.

http://economix.blogs.nytimes.com/2013/08/30/the-central-challenge-in-u-s-health-policy/

Comment:

By Don McCanne, M.D.

The reports cited and the conclusions drawn by Uwe Reinhardt have been covered in our prior messages, but they bear repeating because, as Professor Reinhardt writes, this represents the “central political dilemma in American health policy — leave health care to those who can afford it or increase tax revenues to broaden coverage.”

Typical health care costs for a worker with a family of four – a relatively healthy subset of our society – are now about $22,000, when median household income (not identical to the worker’s family, but still instructive) is now about $50,000. Try pooling that. The numbers don’t work.

Use the link to Reinhardt’s article and check out Figure 4. The bottom one-fifth of households (bottom quintile) has incomes below $20,000. That doesn’t even pay for health care, much less all other essential living expenses. So we have Medicaid for some of them.

Then look at the three middle quintiles – the bulk of working American families. Household income ranges from $20,000 to $100,000, with the median at $50,000. Even at the high end, reducing income from $100,000 to $78,000 because of health care costs puts a strain on budgets that hopefully include retirement plans, tuition expenses, ensuring housing and transportation expenses, perhaps modest vacations, plus the living expenses that would be reasonable for a middle-income family. Even this family needs help with their share of evenly allocated health care costs.

The Affordable Care Act did include a few measures to facilitate a transfer from the wealthy, including income-indexed subsidies for mediocre, low-actuarial-value exchange plans, an expansion of the tax-payer financed, underfunded Medicaid program, and some modest tax increases on higher incomes. But there isn’t really much new help for most middle-income Americans who pay for employer-sponsored plans through forgone wage increases (and at that using inequitable regressive tax expenditures). The Affordable Care Act falls far short of the transfer that will be needed if everyone is to have the health care that they should have.

Single payer advocates already
understand the obvious solution. Do not allocate costs to individuals based on the average costs of their risk categories, which is what individual and group insurance does. Instead, eliminate the insurance plan vehicle of funding and replace it with a universal health care funding pool that is financed based on ability to pay – that is, financed through progressive taxes (and not simply through payroll taxes alone that would hit middle-income workers too heavily).

Single payer calls for not equal but equitable financing, and progressive taxes are the epitome of equitable. Now if only we can get the magnates to agree that improving the health of the nation would be worth their equitable contributions.

Single-payer health care system saves money, time

By Jamie Tobias Neely
The Spokesman-Review (Spokane, Wash.), Sept. 1, 2013

Contrast the following emergency room visits:

One evening a couple of years ago, my husband and I were attending the movie “The Social Network” in downtown Spokane when suddenly I looked over to see my husband’s eye bulging out of its socket.

He couldn’t blink, and he seemed so disoriented that I thought he might be having a stroke. We left the theater before Mark Zuckerberg could make his first million, zipped to a nearby hospital and handed over his insurance card.

After a quick evaluation, the ER doc ruled out anything serious. The diagnosis: sudden onset conjunctivitis or pinkeye, a common childhood malady. He put a few drops in the eye and the muscle relaxed. The bill: $662.24.

When Jill Williams’ husband was snorkeling in New Zealand recently, he dislocated his shoulder. She helped drag him to shore. They traveled to a hospital two hours away. There the hospital staff focused solely on his recovery. The cost to the patient: not a penny.

Williams, who has helped organize a Spokane advocacy group for single-payer insurance, was already convinced other Western countries have better health care systems than ours. The New Zealand experience simply reinforced her conviction.

Today, as rancor continues over the Affordable Care Act, or Obamacare, a number of quiet but determined Washington citizens are pushing for stronger reforms. Like Williams, they’re convinced that Washington should request a waiver from the Affordable Care Act and create the country’s first innovative single-payer system in our state.

It would be similar to Medicare, in which government finances the system but private doctors provide the care. Advocates calculate that by cutting paperwork costs (now estimated to be 31 percent of total health care spending in the U.S.) and forming a huge pool for negotiating drug prices, this new approach could save enough money to cover all of the state’s uninsured residents.

Williams’ book club read “The Healing of America” by journalist T.R. Reid and was inspired by his descriptions of health care systems around the world that are fairer, more effective and considerably more affordable than ours. They helped bring Reid to Spokane for two large community discussions, and they’ve continued to sponsor presentations here. They’ve met with state legislators, partnered with retired physicians and connected with a statewide advocacy group, Health Care for All – Washington.

They’re undaunted by the opposition to Obamacare. One of them worries about her daughter, a single mother who lacks health insurance. “My husband and I are always waiting for the other shoe to drop,” she says.

Another feels frustrated by her insurance company’s “deny first, pay later,” strategy. A third grew up in Canada, where her extended family still can’t believe U.S. residents actually make one another go into bankruptcy when they get sick. That’s 700,000 of us annually, according to a joint study by Harvard Law School and Harvard Medical School.

The women quote Reid’s book. “Those Americans who die or go broke because they happened to get sick represent a fundamental moral decision our country has made,” Reid writes.

How can we not, like citizens in other developed countries, believe it’s only right to take care of one another? “I just don’t get it,” Williams says.

Economically, middle- and upper-class Americans already pay the costs of treating the poor. We and our insurance companies wind up paying $662.24 for a simple eye infection – primarily because hospitals need to charge us exorbitant rates to offset the cost of treating the uninsured.

Williams’ group is forming a speaker’s bureau, and they can be contacted at spokanehealthcare @gmail.com. They want Spokane residents to become well informed on the topic, to contact their legislators and to support smart, strong candidates for public office.

They know it could be a long fight. But these midlife women have watched many impossible battles. At one time, civil rights, laws against sex discrimination and gay rights were all unthinkable in this country. Hopelessly divisive. Polarizing.

And, in the end, all of them came to pass.

So, too, should a single-payer system for the state of Washington.

Jamie Tobias Neely, a former member of The Spokesman-Review’s editorial board, is an associate professor of journalism at Eastern Washington University. Her e-mail address is jamietobiasneely @comcast.net.

http://www.spokesman.com/stories/2013/sep/01/neely-single-payer-health-care-system-saves-money/

Single-payer system needed in health care

By Richard Damon, M.D.
The Billings (Mont.) Gazette, Letters, Sept. 2, 2013

On the PBS program, “Nevada Week in Review,” Sen. Harry Reid was asked, “If ultimately the country would have to have a health care system that abandoned insurance as the means of accessing it.” Reid said, “Yes, yes, absolutely, yes.”

He went on to recount the failure of the public option and the health care voting obstacles in the Senate. In reality, decades of experience with private insurance markets have only produced higher costs for poorer quality plans.

Harvard and CUNY researchers say 30 million in the nation will remain uninsured under Obamacare when fully implemented. Montana had 180,000 residents uninsured prior to the ACA. If Montana continues to opt out of Medicaid expansion, researchers say there will be 149,000 left in Montana without health insurance. If Montana decides to expand Medicaid, there will still be 91,000 people left uninsured.

Public insistence to eventually remedy health care affordability and accessibility with a better program than Obamacare is steadily growing. Public awareness of what is needed is spreading over the country, because of the complexity, the glitches, the confusing requirements and consumer objections mounting in the nation on a daily basis.

Soon, I hope, there will be pubic insistence driving political will to achieve a single payer system that brings accessibility, affordability, better quality and cost containment to health care for every American. The feasibility of such a plan has been touted, tried and proven to be better by other industrialized nations. Churchill’s remarks years ago will be shown to still be apropos, “America usually gets things right after they try everything else.”

Dr. Richard A. Damon resides in Bozeman, Mont.

http://billingsgazette.com/news/opinion/mailbag/single-payer-system-needed-in-health-care/article_503e6de8-b2ee-538a-9bc8-720838fd20e7.html#ixzz2dqO0QtJI

Labor's Love Lost Over Obamacare?

By Steve Early
The Huffington Post, Aug. 30, 2013

Like many labor negotiators, I looked to health care reform for legislative relief from endless haggling with management over employee benefit costs. My own union and others worked hard for passage of President Obama’s Affordable Care Act (ACA) three years ago. Despite its failure to take health insurance issues off the bargaining table, as a more preferable Medicare-for-All system would do, Obamacare was widely cheered by labor.

Union members were told, correctly, that the ACA would expand Medicaid access for millions of lower-income Americans and make private insurance coverage more consumer-friendly for everyone else. Organized labor also expected the new law to aid union bargaining by leveling the playing field among all employers, much like the minimum wage and other protective labor legislation does.

Unions hoped that the ACA would restrain medical cost inflation and corporate pressure for health care cost shifting. Both trends have been a major cause of recent strikes or contract rejections at AT&T, Verizon, and United Parcel Service.

Instead, just months before key ACA provisions go into effect, Obamacare is backfiring in multiple ways on a labor movement already battered and bruised. Contrary to repeated White House assurances, many unionized workers now face more, rather than fewer, health plan problems and costs. Alarmed by Obama administration decisions and ACA provisions unfriendly to labor, top union leaders now fear that Obamacare will create “nightmare scenarios” for millions of workers, retirees, and their families.

Unintended Consequences?

In frantic letters to Congress, national presidents of the Teamsters, Laborers, Hotel Employees, and United Food and Commercial Workers unions cite the multiplying “unintended consequences” of the ACA. Around the country, smaller firms are already outsourcing so they can keep their total head count below 50 and not be covered by ACA requirements. Larger ones, like Wal-Mart, are planning to hire more part-timers and schedule existing employees for less than 30 hours a week so they won’t have to cover their non-fulltime workforce.

Even unionized retailers like Stop & Shop, faced with higher ACA-imposed medical plan costs, are pushing back. The food store chain sought to eliminate health coverage for thousands of part-time workers in New England, creating what one union official called his most difficult negotiations in 40 years.

Under the ACA, federal subsidies for eligible workers who wish to keep their individual job-based insurance won’t help them add or maintain family coverage — because the cost of that is not factored into the ACA subsidy formula. Even lower-income participants in multi-employer plans (known as Taft-Hartley funds) may end up being disadvantaged if ACA rules don’t permit them to qualify for subsidies on the same basis as workers without union-negotiated medical benefits. In both the private and public sector, employers are already citing the ACA’s 2018 tax on mis-named “Cadillac coverage” to justify givebacks from employees who, in reality, only have a healthcare Chevy in their garage.

According to MIT professor Jonathan Gruber, a top White House consultant, this impending 40 percent excise tax on higher cost plans “is intended to shift compensation away from excessively generous health insurance to wages.” Yet few in labor believe that more premium sharing, higher deductibles and co-pays will translate into better pay for workers without a fight over that as well.

Race to the Bottom

The International Brotherhood of Electrical Workers, which faults the ACA for triggering a “race to the bottom with respect to benefits,” is one of those labor organizations still hoping that the White House will make “common sense corrections” in the ACA.

However, the only flexibility that President Obama has shown so far is delaying, until 2015, the law’s requirement that larger employers provide insurance or pay a penalty. Plus, the White House has postponed much-needed limits on out-of-pocket costs for health care consumers. As D. Taylor, president of UNITE HERE, complained to HuffPo’s Dave Jamieson on Aug. 21, the “people who’ve gotten special treatment are the business community… Here’s what we’re saying: ‘You made the problem, you fix it.’ Here we have a situation you can’t blame on the Republicans.”

Labor’s love will certainly be lost, this Labor Day and future ones, if ACA implementation punishes the president’s friends and rewards their corporate adversaries. In 2010, rank-and-file anger over Obama Administration plans to tax union members’ benefits produced a big labor vote in favor of Republican Scott Brown, when he briefly captured a vacant U.S. Senate seat in Massachusetts. The national GOP, which has no positive agenda for health care reform, may yet reap the harvest of wider working-class disillusionment with health care reform.

One leading single-payer activist worries that labor’s growing disaffection with Obamacare will generate more calls for its repeal — a stand already taken by the Roofers Union–followed by “a return to the status quo ante.” This former local union officer fears that a labor movement “more divided and cozying up to the Republicans to teach the Democrats a lesson” is not likely to find a better way forward.

To steer union discontent in a better direction, the Labor Campaign for Single Payer Healthcare has collected hundreds of signatures on an open letter to be distributed to delegates at the national AFL-CIO convention in Los Angeles, Sept. 8-11. The letter urges AFL President Rich Trumka to “push the envelope further” in “the cause of health care justice” by using the shortcomings of Obamacare to build broader support for tax-supported universal coverage that “would take healthcare off the bargaining table.”

Instead, there are strong indications that top AFL-CIO officials want to tamp down any public criticism of ACA and the president (even though they are hailing their 2013 convention as “a time for decisive action to answer the challenges facing working people.”)

Preventing the labor backlash against Obamacare from actually forcing a real discussion on the convention floor will take some doing. In a resolution passed earlier this month, even the Nevada AFL-CIO has joined the public chorus of Obamacare critics, noting that “our health plans only get worse” while the White House fails to respond to serious union concerns.

Steve Early is a labor journalist, lawyer, and retired national staff member of the Communications Workers of America. He was involved, for many years, in bargaining with manufacturing and telecom firms in New England. He is the author, most recently, of Save Our Unions: Dispatches From A Movement in Distress, forthcoming from Monthly Review Press in November. He can be reached at Lsupport@aol.com.

http://www.huffingtonpost.com/steve-early/labors-love-lost-over-oba_b_3838302.html

The tycoons seem to care less about our health care

Large U.S. Employers Project a 7% Increase in Health Care Benefit Costs in 2014, National Business Group on Health Survey Finds

National Business Group on Health, August 28, 2013

The cost of providing employee health care benefits at the nation’s largest employers is projected to increase 7% in 2014 – the third consecutive year employers have budgeted this amount, according to a new survey by the National Business Group on Health, a non-profit association of more than 365 large U.S. employers. The survey – one of the industry’s first look at costs and plan design changes for 2014 – also found that some employers believe health insurance exchanges could be a viable option for certain populations. Additionally, more companies plan to offer workers a consumer-directed health plan as their only health benefits option in 2014.

While large employers will not be eligible to participate in state health exchanges until 2017 at the earliest, employers expect that certain populations may find exchanges to be a viable option on an individual basis in 2014. Roughly four in ten (41%) employers believe COBRA plan participants might find public health exchanges to be the most cost effective option. Additionally, more than one-fourth (26%) felt that some pre-65 retirees might opt to join exchanges, while 20% believe that some part-time employees will do the same.

“Private exchanges are another option some employers are considering. In the last year, there has been an increase in the number of private exchanges that are being launched. And while some employers are considering private exchanges for active employees sometime in the future, very few (3%) are considering eliminating health care coverage entirely,” said Darling.

More Employers Embracing Total Replacement CDHPs

The survey found that implementing a consumer-directed health plan (CDHP) was considered the most effective tactic to control rising costs, cited by more than one-third of respondents (36%). In fact, nearly three-quarters of employers (72%) now offer at least one CDHP. This number has remained relatively steady over the last couple of years. However, the number of employers that are offering only a CDHP to employees continues to rise, with 22% planning to implement a total replacement CDHP next year, up from 19% this year.

(The National Business Group on Health members are primarily Fortune 500 companies and large public sector employers — including the nation’s most innovative health care purchasers — who provide health coverage for more than 55 million U.S. workers, retirees, and their families.)

https://www.businessgrouphealth.org/pressroom/pressRelease.cfm?ID=214

Comment:

By Don McCanne, M.D.

The National Business Group on Health survey is important because it represents the views of the nation’s largest employers who provide coverage for over 55 million workers and their families – supposedly the best health benefit programs available. Three findings in this survey should have us concerned.

1)  The costs of providing health care benefits have increased at the rate of 7 percent for each of the past three years, considerably higher than the rate of inflation. This indicates that health care costs continue to increase at unsustainable rates, regardless of the implementation of several programs supposedly designed to slow spending increases.

2)  Although large employers cannot use the state health exchanges until 2017, interest in both private exchanges and state exchanges is increasing. A major attraction of the exchanges is that employees are most likely to select plans with actuarial values of only 60 to 70 percent because of their lower premiums. This offers employers the opportunity to shift from defined health benefits to defined contributions for the exchange plans. This shifts more of the health care costs to employees.

3)  About three-fourths of employers now offer consumer-directed health plans (CDHPs), and next year 22 percent will offer CDHPs as the only option. CDHPs are high deductible plans that shift more costs to employees and their families. Some may be associated with a health spending account, but that is little more than a tax gimmick that favors higher income employees. Whether these accounts are funded by direct employee contributions or by employer contributions representing forgone wage increases makes little difference as far as whether or not health care is more affordable. It is ultimately the employee that is responsible for the increases in out-of-pocket costs.

The National Business Group on Health represents two-thirds of the Fortune 100 companies – the biggest of the biggest. They should be offering the very best. But instead, these trends should make us want to accelerate our movement away from employer control of individual health plans and toward enactment of a single, publicly-financed national health program that would include everyone and treat all of us fairly. The tycoons seem to be losing interest in the welfare of their employees, so what chance would the rest of us have without converting to an improved Medicare that covered everyone?

The unsteady rollout of Obamacare

By Caroline Poplin, M.D.
McClatchy-Tribune News Service, Aug. 26, 2013

Any program as large and complex as Obamacare (not to mention one facing such entrenched opposition) is going to encounter some turbulence on its shakedown cruise. But the recent glitches are as important for what they tell us about reform, as for what they do.

Obamacare (more formally, the Patient Protection and Affordable Care Act) will cover millions of currently uninsured Americans as advertised — but with as little disruption to corporate profits as possible. Patients and taxpayers are to shoulder most of the additional cost.

The administration will delay for one year — until 2015 — the requirement that large employers offer their employees decent insurance, or pay a small penalty (the so-called “employer mandate”). There was no corresponding delay of the individual mandate, the requirement that all citizens sign up for insurance coverage starting in 2014, the most unpopular provision of ACA. This means that next year employees of the recalcitrant firms will have to buy health insurance without any contribution from their employers.

The Congressional Budget Office estimates this delay could affect up to a million people. If families cannot afford the insurance offered on the new exchanges, and fall below 400 percent of the poverty line, taxpayers will pick up part of the tab. The Kaiser Foundation calculates that about half the uninsured will qualify for Federal subsidies.

Congressional Republicans (and some Democrats) passed a bill to delay the individual mandate also. However, no one in Washington really wants that; it would hurt the insurance companies, who are adamant that young, healthy individuals be required to enroll so as to cover the costs of the sick, who will sign up right away.

The administration also quietly postponed for a year ACA annual and lifetime limits on out-of-pocket costs in some employer-sponsored plans. This delay will fall hardest on the sickest — patients with diseases like cancer, multiple sclerosis, or HIV, where the costs of drugs alone can easily exceed $100,000 a year.

Democrats winced and largely remained silent. Republicans chortled, passed another symbolic bill, and continue to obstruct the ACA wherever they can.

Business contended — and the administration apparently agreed — that these two provisions were too complicated to implement on time. However, these are large corporations that deal with complex matters all the time — and they had three years to plan. By contrast, figuring out the new exchanges, benefit packages and tax subsidies will be at least as difficult for individuals, who get just three months to plan; most exchanges will not be up until October, and people must enroll by January.

Is there something wrong with this picture?

Don’t misunderstand: extending health insurance coverage to millions of uninsured and underinsured Americans is an unequivocal good, and a substantial step forward.

However, the U.S. pays the highest prices in the world for health insurance and health care. Notwithstanding its name, the Affordable Care Act extends this extravagantly expensive system to the uninsured with little attention to reducing or spreading the cost, just a hope and a prayer that the invisible hand of the market will somehow do the heavy lifting. The law puts minimal burdens on corporations, who are sitting on record profits, even though wages, out of which families must pay the new premiums, continue to stagnate.

Politicians tell us that this market-driven system, heavily reliant on consumer payments and subsidies, is the only one that Americans today will accept. Maybe.

Yet keep in mind that the U.S. is the outlier here. In one way or another, all the other advanced Western democracies regulate insurers, hospitals, doctors and manufacturers to ensure that all their citizens (sometimes even visitors!) receive the health care they need, with modest profits to providers.

Indeed, we have such “socialized” health insurance already, hiding in plain sight: Medicare, the most popular program in the country after Social Security. Medicare covers all services that are medically necessary (except eyeglasses and hearing aids), at lower cost, and with far less complexity, than private health insurance. People pay according to their income. Employers are required to contribute for all employees, including part-timers. There are no restrictions on patients’ choice of hospital or doctor. We could easily finance the extension of Medicare with the money that goes for private premiums now.

For the sake of millions of uninsured citizens, I hope the rollout of the peculiarly American ACA is successful. But if it turns out to be too complex or too expensive, voters have a cheaper, simpler, fairer alternative. Employers, insurers and providers, take heed.

Caroline Poplin is a physician, attorney and policy analyst in Bethesda, Md. She wrote this column for McClatchy-Tribune News Service.

Read more here: http://www.mcclatchydc.com/2013/08/26/200353/the-unsteady-rollout-of-obamacare.html#.Uh4Zc5g_e6o#storylink=cpy

Medicare for all

By Bob Balhiser
Independent Record (Helena, Mont.), Letters, Aug. 28, 2013

I am no fan of “Obamacare” because it allows some 1,300 private insurers to profit from our medical misfortunes. When that many companies have their ‘fingers in the pie’ everyone pays an extra price. We pay not only in dollars but in complexity, as demonstrated by Mike Dennison’s Sunday IR article on the subject.

It is well known that we in the U.S. pay far more overall for health care than other advanced countries. In fact, we pay nearly 18 percent of Gross Domestic Product while other advanced countries pay an average of 11 percent GDP. In our economy, that 7 percent GDP difference amounts to about $1 trillion in annual potential savings. Yes, we are talking $1,000,000,000,000 annually … that’s a lot of money to throw away on huge profits, administrative costs and other non-productive efforts.

Medicare-For-All, done right, would recapture much of this misspent money in the three following ways: by eliminating health insurance company profit and administrative costs; by relieving doctors, hospitals, clinics and pharmacies of the unnecessary paperwork burden and other costs and rules that numerous private insurers impose on them, and by bargaining with giant pharmaceutical companies to reduce drug costs to levels that Canadians pay.

Given the tenuous financial circumstances we face in the U.S., isn’t it time to give some serious consideration to the huge savings that could be realized by implementing Medicare-For-All?

The writer lives in Helena.

http://helenair.com/news/opinion/readers_alley/medicare-for-all/article_5340fc00-0f71-11e3-9c70-0019bb2963f4.html

The Des Moines Register is back on message

The Register's Editorial: Why tie insurance to jobs?

By the Editorial Board
The Des Moines Register, August 27, 2013

In many households, one spouse buys health insurance through a job for the entire family. Now United Parcel Service Inc. has announced it intends to cut this coverage for working spouses of nonunion employees next year.

A UPS spokesman said the change is necessary to keep costs down.

Denying insurance to workers’ spouses will certainly create a financial burden for families, particularly if companies don’t reduce the premiums for workers when they implement such a change. Now the family needs to purchase two policies to cover both adults in the home. Also, the health insurance offered by the spouse’s employer may not cover needed services or may impose higher co-payments and deductibles.

Unfortunately, this is how things work in a country that has tied health insurance to employment. We have long recognized that is a bad idea. Your employer doesn’t select and subsidize your homeowner’s insurance or your car insurance.

The practice burdens U.S. businesses and puts them at a disadvantage in a global economy. In other countries, the government facilitates coverage for everyone.

Employer-based health insurance creates problems for workers. They are at the mercy of their company when it comes to which plans are available.

In some ways, the health reform law addresses some of these problems.

Yet the Affordable Care Act is built on a broken system. As the Register’s editorial board wrote for years prior to the passage of the health law in 2010, this country needs a single-payer health care system with coverage facilitated by the government. Similar to Medicare, everyone could contribute through taxation and everyone would be covered. Instead of such a change, Congress cemented in place the practice of tying health insurance to jobs by requiring many companies to offer it.

The long term result will likely be more companies doing exactly what UPS is doing.

http://www.desmoinesregister.com/apps/pbcs.dll/article?AID=2013308270030

Comment:

By Don McCanne, M.D.

We already knew that The Des Moines Register held an editorial position in favor of single payer reform, but this reiteration of their position is highly significant.

Much of the activity in support of single payer has faded as attention has turned to implementation of the Affordable Care Act. The prevailing attitude is that, well, we tried and this is the best that we could get. We can work on trying to patch this system, but forget trying to negotiate the major barriers erected by obdurate politicians. Even if current laws and regulations have locked up much of the nation’s health care funds, we’ll just try to muddle our way through with incremental steps using some future form of magical waivers which we will need since the currently available waivers, including those in the Affordable Care Act, cannot change the basics of the fundamentally flawed, fragmented infrastructure of multiple public programs and private plans, or no plans at all for far too many of us.

What is so important about today’s message is that the Register’s editorial board sees through this nonsense. “The Affordable Care Act is built on a broken system.” Congress has “cemented” into place this highly dysfunctional infrastructure. Incremental steps cannot work when we are heading down the wrong pathway.

As the Register states, “This country needs a single-payer health care system with coverage facilitated by the government – similar to Medicare, everyone could contribute through taxation and everyone would be covered.”

The Des Moines Register is back on message. We have to get back on message as well.